Father Michael Prieur on "staying in the game".

In a Challenge magazine interview with Herman Gooden (March 2001), Father Michael Prieur, Professor of Moral and Sacramental Theology at St. Peter's Seminary, London, ON, discussed the question of material cooperation with morally evil acts. He gave as an example the question whether a Catholic hospital could cooperate with tubal ligation, performed for the purpose of contraception. He admitted that the ligation is an evil act, but said that it is allowed under two sets of circumstances:

1) under "material cooperation", and

2) because it can be tolerated "for a greater good"

"We live in a messy world," he said, "the alternative...do we get out of health care completely?"

Objections

There are serious objections to this approach. The Church teaches that contraceptive sterilization is absolutely forbidden; and nothing can justify a Catholic hospital in cooperating with it. Material cooperation, with the necessary distinctions between necessary and freely given cooperation, proximate and remote cooperation, remains valid, but must be applied very prudently when the case demands it. Even here, however, the danger of causing confusion and scandal must be avoided. If Catholic hospitals merge with institutions which do not act according to Catholic moral principles, they must show that their cooperation is not formal, and if material, that it is appropriately explained.

Father Prieur's thesis fails as an example of legitimate cooperation and also an example of toleration of evil "for a greater good."

Principles

The principles governing cooperation with evil are among the trickiest in moral theology. Certain carefully circumscribed cooperation with evil to prevent evil is allowed. The relevant questions are:

1) How evil is the evil? Contraceptive sterilization, either by fallopian tube ligation or vasectomy, is an intrinsic evil, as is an abortion.

2) Is the cooperation formal? Does the Catholic hospital agree with the purpose of the operation; that is, permanent sterilization? Some Catholic hospitals claim that they don't agree with the intent to sterilize, but still allow the operation. This reminds one of the politicians who are personally opposed to abortion, but still support it.

3) Is there implicit formal cooperation? The cooperator does not intend the evil himself but clearly realizes that his cooperation will help to produce the evil, which would not occur otherwise in that hospital. This is always wrong. It would be very difficult for a Catholic hospital cooperating with physicians who perform sterilizations in the hospital and use the instruments and personnel supplied by the hospital to argue that they are not giving implicit formal cooperation.

4) Even if there is no intention to achieve the evil, there can be material cooperation. This is of two kinds, immediate (proximate) and mediate (remote). Immediate implies direct or essential participation. This is always wrong, except in the rare case where the cooperator is under duress. An example of duress would be if an anesthetist had to continue with anesthesia of a patient when an obstetrician, having just performed a Cesarean section, proceeded without warning, to ligate the woman's tubes. Mediate cooperation implies indirect or remote cooperation in evil. This can be justified only if some other evil would result from failure to cooperate. For example, a clerk in the admitting office of the hospital filling out the admission forms for a woman admitted for sterilization. Even in this case, it might not be justified if it gave scandal. Scandal is not a mere shock or surprise. It is any action--word, deed or omission--which is either evil or has the appearance of evil and is likely to furnish an occa sion of sin for others.

Father Prieur

Father Prieur tells us that "We tolerate something for the greater good, the greater good being the health of the woman." However, in 1975, the Congregation for the Doctrine of the Faith, in its document Statement on Sterilization, stated that purposely sterilizing cannot be justified "for the greater good of the person," because "it damages the ethical good of the person, which is the highest good, since it deliberately deprives foreseen and freely chosen sexual activity of an essential element."

A Catholic hospital which provides space, equipment and personnel so that a physician can contravene Catholic ethical norms is a source of scandal. Such a facility is clearly providing something essential to the performance of the sterilization, and is therefore giving immediate material cooperation. This cannot be justified by the claim that the cooperator is under duress, nor can it be truly described as remote cooperation. The possibility of scandal, and of creating confusion about Catholic moral teaching, cannot be ruled out.

Role of Catholic institutions

Well-known moral theologian Germaine Grisez maintains that Catholic institutions are supposed not only to avoid evil, but to do good, and cannot do either by associating with evil, even indirectly. "The business of a Catholic institution like a hospital is precisely to bear witness to the Faith," he says. Father Prieur, on the other hand, fears that because governments are forcing hospitals to merge with public ones, "we may find ourselves euchred out." "I think that the answer to that,' Grisez says, "is that going out of business is not the worst thing in the world." He believes that the days of Catholic hospitals may be over. The acute care hospital is now extremely costly to own and to operate. The day may be near when Catholics should consider instead the provision of care for those who are falling through the cracks in our system; e.g., the dying who need palliative care.

Certainly, it cannot be legitimately claimed that "staying in the game" is a greater good which justifies contraceptive sterilization in a Catholic hospital. A "greater good" can only justify remote cooperation, and then only when there is no possibility of scandal.